4. Better Sleep 😴
Night sweats are the obvious culprit for disrupted sleep, but even without them, hormonal fluctuations during perimenopause can wreak havoc on sleep quality. Progesterone, in particular, has natural calming and sleep-supportive effects.
By restoring hormone levels, HRT helps many women fall asleep faster, sleep more deeply, and wake up feeling more rested. Poor sleep doesn’t just affect how you feel — it negatively impacts metabolism, mood, immune function, and longevity.
5. Lower Risk of Type 2 Diabetes 🩸
As estrogen declines, the body becomes less responsive to insulin which increases the risk of insulin resistance, prediabetes, and eventually type 2 diabetes. This is a lesser-known but clinically significant consequence of menopause.
A 2024 meta-analysis of 17 randomized, controlled trials covering more than 29,000 participants found that hormone therapy significantly reduced insulin resistance in healthy postmenopausal women — for both oral and transdermal forms. A separate 20-year cohort study reinforced this, linking HRT to a meaningfully lower incidence of diabetes in women ages 46–60.
6. Better Body Composition & Muscle Health 💪
Many women notice increased fat accumulation, especially around the midsection, and loss of muscle tone during perimenopause. This isn’t just about lifestyle; it’s directly tied to hormonal changes.
Estrogen supports muscle protein synthesis and fat distribution. Testosterone (yes, women have it too, and it declines with age) plays a key role in muscle mass and strength. Optimizing these hormones through HRT can support better body composition outcomes — particularly when paired with resistance training and adequate protein intake.
7. Revitalized Libido & Sexual Health 🔥
Declining estrogen and testosterone during menopause can lead to vaginal dryness, discomfort during sex, and reduced sexual desire. These changes are common, but they’re not inevitable. Research shows that combined estrogen-testosterone therapy can meaningfully improve both sexual comfort and desire in postmenopausal women.
What About the Risks?
It’s a fair question — and the honest answer is: the risk profile of HRT has improved significantly since the early 2000s.
The landmark 2002 Women’s Health Initiative (WHI) study raised concerns about HRT and breast cancer, heart disease, and stroke. But that study used synthetic progestins (not bioidentical progesterone) and included women who were well past the optimal treatment window.
Today’s HRT is different. A 2024 JAMA study confirmed that HRT is safe and effective for most women under 60 who start within 10 years of menopause. Modern formulations use bioidentical hormones, lower doses, and transdermal delivery (patch, gel, or cream) when appropriate. Curious about what getting started actually looks like? Check out what to expect before starting HRT.
As with any medical treatment, HRT isn’t right for everyone — and it should always be individualized. Women with a history of certain hormone-sensitive cancers, active liver disease, or undiagnosed vaginal bleeding should discuss their full health picture with a provider.
Final Thoughts
Hot flashes are just the tip of the iceberg. HRT can protect your bones, your heart, your metabolism, your sleep, and your quality of life — when it’s the right fit and started at the right time.
At Thrive, we take a comprehensive, biomarker-driven approach to hormone optimization for women. If you’re experiencing symptoms of perimenopause or want to understand your hormone health, our team is here to help you build a personalized plan.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
